Osteoarthritis and Priciples of Management

Question 1

Define osteoarthritis

Answer 1

• “Tear, flare and repair”
• Due to aging and wear and tear on a joint
• Trauma + mechanical imbalance
• Inflammation + pain
• Repair processes around the joint

Question 2

Biochemical risk factors for OA

Answer 2

• Obesity
• Persistent heavy physical activity or elite running
• Abnormal anatomy (DDH)
• Ligament rupture
• Meniscal injury
• Occupation (sportsmen, farmers)

Question 3

Describe the inflammation seen in OA

Answer 3

• Synovial hypertrophy
• Subchondral changes
• Joint effusion

Question 4

Signs + symptoms of OA for localised disease

Answer 4

• Usually hip or knee
• Pain on movement + crepitus
• Worse at end of day
• Background pain at rest
• Joint gelling (stiffness after 30mins rest)
• Joint instability
• May be joint tenderness, derangement + bony swelling

Question 5

Red flags of suspected OA presentation

Answer 5

• Trauma
• Prolonged morning related stiffness
• Rapid deterioration of symptoms
• Hot swollen joint

Question 6

DDx of OA

Answer 6

• Gout
• Other inflammatory arthritis
• Septic arthritis
• Malignancy

Question 7

4 non-pharmacological Rx for OA

Answer 7

• Thermotherapy
• Electrotherapy
• Manual therapy
• Aids + devices
• Exercise to improve local muscle strength
• Weight loss if overweight

Question 8

Pharmacological Rx of OA

Answer 8

• Regular analgesia (paracetamol +/- topical NSAIDs/capsaicin)
• If ineffective give codeine or short term oral NSAIDs (+PPI (omeprazole) )
• IA steroids with severe symptoms

Question 9

When to refer OA patient to surgery

Answer 9

• Substantial impact on QOL

- Refractory to non-surgical treatment

Question 10

What does the LOSS pneumonic refer to

Answer 10

• Loss of joint space
• Osteophytes
• Subarticular sclerosis
• Subchondral cyst

X-ray features of OA

Question 11

Typical age of onset of OA

Answer 11

> 50yrs

Question 12

Examples of 3 conditions OA is secondary to

Answer 12

• Haemochromatosis
• Obesity
• Occupational

Question 13

Investigations for OA

Answer 13

• Plain radiograph (shows LOSS)
• CRP may be slightly elevated
• Aspiration of joint fluid (look for blood, pus +/or crystals) + send it for gram stain + polarised light microscopy

Question 14

What are the bony swellings in OA, where are found commonly and what causes them

Answer 14

• Herberden’s nodes
• Usually DIP joints
• They are a sign of OA
• Caused by formation of osteophytes of the articular cartilage in response to repeated trauma at the joint

Question 15

Swellings on the DIP + PIP

Answer 15

• DIP = Herberden’s nodes (sign of OA)

- PIP = Bouchard’s nodes (sign of OA + RA)

Question 16

Surgical treatment for OA

Answer 16

Joint replacement